Monitoring and long-term outcomes in vascularized composite allotransplantation.

Purpose Of Review: The field of vascularized composite allotransplantation (VCA) is young, with less than 150 transplants worldwide. However, we now possess as much as 14 years of clinical follow-up. There are similarities and distinct differences between solid-organ transplantation (SOT) and VCA.

The genetic heterogeneity and mutational burden of engineered melanomas in zebrafish models.

Background: Melanoma is the most deadly form of skin cancer. Expression of oncogenic BRAF or NRAS, which are frequently mutated in human melanomas, promote the formation of nevi but are not sufficient for tumorigenesis. Even with germline mutated p53, these engineered melanomas present with variable onset and pathology, implicating additional somatic mutations in a multi-hit tumorigenic process.

Response of dupuytren fibroblasts to different oxygen environments.

Purpose: It is thought that local ischemia and oxygen radicals are responsible for fibroblast-to-myofibroblast cell transformation and proliferation. We hypothesized that hypoxia could differentially activate the contractility of fibroblasts from normal human palmar fascia and from fibroblasts-myofibroblasts of Dupuytren cords.

Methods: Normal palmar fascia from 5 patients with carpal tunnel syndrome and Dupuytren cords from 5 patients were harvested.

Trajectories of substance use among young American Indian adolescents: patterns and predictors.

Substance use often begins earlier among American Indians compared to the rest of the United States, a troubling reality that puts Native youth at risk for escalating and problematic use. We need to understand more fully patterns of emergent substance use among young American Indian adolescents, risk factors associated with escalating use trajectories, and protective factors that can be parlayed into robust prevention strategies. We used growth mixture modeling with longitudinal data from middle-school students on a Northern Plains reservation (Wave 1 N = 381, M age at baseline = 12.

Multilevel context of depression in two American Indian tribes.

Objective: Depression is a major debilitating disease. For American Indians living in tribal reservations, who endure disproportionately high levels of stress and poverty often associated with depression, determining the patterns and correlates is key to appropriate clinical assessment and intervention development. Yet little attention has been given to the cultural context of correlates for depression, including the influence of family, cultural traditions or practices, or community conditions.

What currently defines a breast center? Initial data from the national accreditation program for breast centers.

Purpose: The definition of a "breast center" varies significantly, ranging from hospital-based or free-standing comprehensive programs to private subspecialty practices with patient resources in close proximity. This study analyzes the 2-year data of the National Accreditation Program for Breast Centers (NAPBC) to assess the demographics of the types of programs seeking breast center (BC) accreditation. The results of a postaccreditation survey are also analyzed.

Rural native veterans in the Veterans Health Administration: characteristics and service utilization patterns.

Purpose: The Department of Veterans Affairs (VA) and the Indian Health Service (IHS) signed a Memo of Understanding in 2010 to strengthen their partnership in improving health care services for Native veterans, who are disproportionately rural. This paper describes the demographic and service use profile of rural Native veterans who access VA health care.

Methods: Data were abstracted from the 2008 Veteran Health Administration (VHA) medical dataset, and the characteristics of rural Native veterans were compared to rural non-Native veterans.

Small molecule screening in zebrafish: swimming in potential drug therapies.

Phenotype-driven chemical genetic screens in zebrafish have become a proven approach for both dissection of developmental mechanisms and discovery of potential therapeutics. A library of small molecules can be arrayed into multiwell plates containing zebrafish embryos. The embryo becomes a whole organism in vivo bioassay that can produce a phenotype upon treatment.

Mechanical versus manual chest compressions in out-of-hospital cardiac arrest: a meta-analysis.

Objective: The objective of this study was to conduct a meta-analysis of literature examining rates of return of spontaneous circulation from load-distributing band and piston-driven chest compression devices as compared with manual cardiopulmonary resuscitation.

Data Sources: Searches were conducted in MEDLINE, the ClinicalTrials.gov registry, and bibliographies on manufacturer websites for studies written in English.

Project TEACH: A Capacity-Building Training Program for Community-Based Organizations and Public Health Agencies.

Project TEACH (Teaching Equity to Advance Community Health) is a capacity-building training program to empower community-based organizations and regional public health agencies to develop data-driven, evidence-based, outcomes-focused public health interventions. TEACH delivers training modules on topics such as logic models, health data, social determinants of health, evidence-based interventions, and program evaluation. Cohorts of 7 to 12 community-based organizations and regional public health agencies in each of the 6 Colorado Area Health Education Centers service areas participate in a 2-day training program tailored to their specific needs.

Modeling paternal attentiveness: distressed pups evoke differential neurobiological and behavioral responses in paternal and nonpaternal mice.

With the exception of parturition and lactation, male California deer mice (Peromyscus californicus) exhibit the same parental responses toward offspring as conspecific females. A closely related species, Peromyscus maniculatus, however, rarely exhibits paternal responses. In the current study, a comparative species approach was used to assess paternal responses in both Peromyscus species with varying levels of paternal experience (biological fathers, pup-exposed virgins, and pup-naïve virgins).

Changes in JC virus-specific T cell responses during natalizumab treatment and in natalizumab-associated progressive multifocal leukoencephalopathy.

Progressive multifocal leukoencephalopathy (PML) induced by JC virus (JCV) is a risk for natalizumab-treated multiple sclerosis (MS) patients. Here we characterize the JCV-specific T cell responses in healthy donors and natalizumab-treated MS patients to reveal functional differences that may account for the development of natalizumab-associated PML. CD4 and CD8 T cell responses specific for all JCV proteins were readily identified in MS patients and healthy volunteers.

Effort-Based Reward (EBR) training enhances neurobiological efficiency in a problem-solving task: insights for depression therapies.

Effort-Based Reward (EBR) training strengthens associations between effort and rewards, leading to increased persistence in an unsolvable task when compared to control animals. EBR training involves placing animals in a test apparatus in which they are trained to dig in mounds to retrieve froot loop rewards (contingent group); these animals are compared to control animals that are given the same number of rewards, regardless of expended effort (noncontingent group). In the current study, the effect of EBR training on performance in a spatial task (Dry Land Maze) was explored to determine cognitive resilience during behavioral testing.

Geographical access and the substitution of traditional healing for biomedical services in 2 American Indian tribes.

Objectives: American Indians who live in rural reservation communities face substantial geographic barriers to care that may limit their use of health services and contribute to their well-documented health disparities. The purpose of this study was to examine the impact of geographical access to care on the use of services for physical and mental health problems and to explore American Indians' use of traditional healing services in relation to use of biomedical services.

Methods: We analyzed survey data collected from 2 tribes (Southwest and Northern Plains).

A randomized trial to evaluate a launderable bed protection system for hospital beds.

Background: Hospital beds are potential reservoirs of bacteria in hospitals. Preventing contamination of the bed and providing a cleaner surface should help prevent hospital-acquired infections (HAIs). Most hospital beds are cleaned between patients (terminal cleaning) using quaternary ammonia compounds (quats).

A framework for conducting a national study of substance abuse treatment programs serving American Indian and Alaska native communities.

Background: Because of their broad geographic distribution, diverse ownership and operation, and funding instability, it is a challenge to develop a framework for studying substance abuse treatment programs serving American Indian and Alaska Native communities at a national level. This is further complicated by the historic reluctance of American Indian and Alaska Native communities to participate in research.

Objectives And Methods: We developed a framework for studying these substance abuse treatment programs (n ≈ 293) at a national level as part of a study of attitudes toward, and use of, evidence-based treatments among substance abuse treatment programs serving AI/AN communities with the goal of assuring participation of a broad array of programs and the communities that they serve.

Patterns of substance use initiation among young adolescents in a Northern Plains American Indian tribe.

Background: Substantial evidence documents problematic substance use in Northern Plains American Indian communities. Studies suggest that disparities can be traced to disproportionate rates of early substance use, but most evidence comes from the retrospective reports of adults or older adolescents.

Objective: To use a prospective longitudinal design to examine substance use initiation patterns as they emerge among young American Indian adolescents.

Circle of Life HIV/AIDS-prevention intervention for American Indian and Alaska Native youth.

This article describes the objectives, theoretical bases, development process, and evaluation efforts to-date for the Circle of Life (COL) curricula, HIV/AIDS prevention interventions designed for American Indian and Alaska Native (AI/AN) youth. The curricula are based on Indigenous models of learning and behavior encompassing concepts of Western theories of health behavior change. The curricula underwent extensive national and community review.

Graft vasculopathy in clinical hand transplantation.

Allogeneic hand transplantation is now a clinical reality. While results have been encouraging, acute rejection rates are higher than in their solid-organ counterparts. In contrast, chronic rejections, as defined by vasculopathy and/or fibrosis and atrophy of skin and other tissues, as well as antibody mediated rejection, have not been reported in a compliant hand transplant recipient.

Impact of epilepsy surgery on seizure control and quality of life: a 26-year follow-up study.

Purpose: The short-term efficacy and safety of epilepsy surgery relative to medical therapy has been established, but it remains underutilized. There is a lack of data regarding the long-term seizure-control rates and quality of life outcomes after epilepsy surgery. This study represents the longest follow-up study to date, with a mean follow-up duration of 26 years.

World experience after more than a decade of clinical hand transplantation: update from the Louisville hand transplant program.

In the last 12 years, the Louisville CTA program has screened more than 600 interested hand transplant candidates and has transplanted 6 patients with 7 hand allografts. The program is a collaborative effort between the surgeons and staff of Kleinert, Kutz and Associates, Jewish Hospital and St. Mary's Healthcare, the Christine M.

Can we measure the quality of breast surgical care?

Many studies have demonstrated gaps in healthcare quality for all medical and surgical specialties including breast surgical care. How to optimally measure and improve quality has generated debate at the local, state, and national level. Attempts to judge medical performance by private companies using non-risk-adjusted administrative databases may not be accurate and may unfairly penalize surgical care.

Torsion and dyssynchrony differences between chronically paced and non-paced heart failure patients.

Background: Chronic right ventricular pacing may lead to left ventricular dyssynchrony, systolic dysfunction, remodeling, and heart failure. Cardiac mechanics may differ between paced and nonpaced heart failure patients, and their optimal treatment may also differ.

Methods And Results: Echocardiograms were analyzed using tissue Doppler imaging and speckle tracking echocardiography in 20 patients with chronic right ventricular pacing for complete heart block (RVP group), 29 nonpaced patients with different heart failure etiologies but ejection fractions similar to the RVP group (HF group), and 25 control subjects without pacemakers or heart failure (control group).